Abstract
Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-016-0352-z) contains supplementary material, which is available to authorized users.
Highlights
At least one in four people in the UK will experience a mental health problem and up to two percent of the population will be diagnosed with a serious mental illness (SMI) during their lifetime [1]
Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics
Despite more prescribers and service users supporting shared decision-making (SDM), it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff
Summary
At least one in four people in the UK will experience a mental health problem and up to two percent of the population will be diagnosed with a serious mental illness (SMI) during their lifetime [1]. For the purposes of this research SMI is considered to include diagnoses that are treated with antipsychotics, typically schizophrenia and bipolar affective disorder [2]. Adherence presumes agreement about the proposed medication, between the prescriber and the person taking the medicine, emphasising the importance of shared decision-making (SDM; [4]). Studies have found that 75 % of people with chronic schizophrenia discontinue their medication within 18 months [8] and non-adherence rates in bipolar disorder range between 20 and 60 % with a mean of 41 % [9, 10]. People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. There is currently little data on the opinions of health professionals on the role of SDM
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